Ruptured Mycotic Aneurysm in a Patient with Aortic Regurgitation: Follow-up Observation by Transcranial Doppler Sonography

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A 52-year-old man with aortic regurgitation (AR) presented with a subarachnoid hemorrhage (SAH) due to a ruptured mycotic aneurysm. Transcranial Doppler sonography (TCD) of the left middle cerebral artery demonstrated an increased peak systolic flow velocity (FV_max) of 95 cm/s and no flow during the end-diastolic phase. Management of cerebral vasospasm giving consideration to cardiac function was successful, and no further increase of FV_max was observed. After replacement of the aortic valve, TCD showed normalization of the wave contour compared with that before replacement. As AR patients are prone to cerebral vasospasm due to end-diastolic cerebral hypoperfusion, serial observation by TCD is helpful for management.